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'- _ <br /> P�1tMIT APPLICATiON <br /> CITY OF EV�RETT PERMIT SERVICES <br /> /! C/ � � /] � 3200 CEDAR STREET, EVERETT, WA 98201 <br /> �`� 4�25-257-8810— FAX 425-257-8857—www.everettwa.org <br /> SiLVr'RLirE skopp�n�r APPLICATIONS ARE ACCEPTED FROM 8 AM f0 4 PM g/�/�03_�(�/S <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �1," AUc SF �-t (IZ�`'S-f N� (.e03 '01 D <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER � AODRESS CITY2IP PHONE <br /> s�ro-f�u L ����(i� �- �i�- cor6� �}vr sf� �z oz� <br /> TENANTNAME CONTAC FORPERMIT PHONF. <br /> I J:e.t�-� �v�9 y 8� 2/ . <br /> CONTRACTORt�,�� e P�uM ,n� ADDRESS ��3�/ ��,5-�- CITY2IP PHONE <br /> s� ,s-u� B `rd�'�a 3Lo �Hy - 6�2/ <br /> CONTR.LICENSE# �Na�CPSd33�J <br /> USE OF BUILDING 1 HEAT SOURCE CONTRACT PRIC-E OF WORK <br /> �r�+'��f- �-rnP��C�1Vl,��l'�1 _Electric _Gas_Other ��v � <br /> WORK DESCRIPTION <br /> Grm,�v�cQ wo-r�� �ouo� ti -3� �-� rtzz���r, P�c�,v,-�bii�ty <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR I7EM <br /> � Toilel A1C—air handling units <br /> Bathtub Forced air systems <br /> �� Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Cishwasher Gasrange <br /> Clolnes washer Ciothes dryer <br /> � Water heater Range hood <br /> Sink(service/har/mop/etc.) Exhaust fan <br /> Backilow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeration <br /> Grease Vap Woodslove <br /> Roof c!rain,s� Other <br /> 7 Other t7U8 �YU(i7 — <br /> CITY OF EVEREIT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify thal i have read and examined lhis app�icalion and know the same lo be true and correct. All provisions of laws and <br /> ordinaces governing lhis type of work will be complied with whether specified herein or not.The granting of a permil does not presume <br /> to give authority to violate ancel the provision of any other state or local!aw regulating construction or the pedormance of <br /> construction.That I am at ho zed by the owner of this property to pertorm the work for which app�ication is made and I comply with the <br /> St e Contractors Law 1 2 C and 296.200 WAC. <br /> � 3 -Z `j-o� <br /> Sig alure of OwnedContrectorlAuthorized P.genl Date <br />